Surgical Results of Laparoscopic Cholecystectomy for Gallbladder Torsion.

Gallbladder torsion (GT) causes ischemia of the gallbladder, which potentially leads to a fatal condition. Consequently, GT requires urgent treatment. An urgent laparoscopic cholecystectomy (LC) might be the optimal approach, in view of the anatomical abnormality, "floating gallbladder," which is associated with GT. However, the feasibility of LC for GT has not been well investigated. Thus, in this study, we investigated the feasibility of LC for GT in a case series. A total of 393 patients underwent urgent LC for acute gallbladder diseases at our institution during the study period. Among these patients, six had GT (1.5%) and were enrolled in this study. We retrospectively analyzed the surgical results of LC. Of the six cases, four (66.7%) were correctly diagnosed with GT preoperatively. There were two cases of Type I and four cases of Type II, based on the Gross classification for GT. The median operation time and intraoperative bleeding volume were 64 minutes and 18 mL, respectively. No cases required conversion to open surgery. All six cases experienced an uneventful postoperative course. The median postoperative hospital stay was six days. The surgical results of LC were favorable for six cases of GT. These results showed that LC was feasible for GT.

[Intraoperative Assessment of Blood Flow in the Remnant Stomach Using Indocyanine Green and Regional Oxygen Saturation Monitoring at Distal Pancreatectomy Following Gastrectomy].

A92 -year-old man was diagnosed with pancreatic cancer 14 years after undergoing distal gastrectomy for gastric cancer. His remnant stomach was fed by the cardiac branch of the left inferior phrenic artery, short gastric artery, and posterior gastric artery. We planned distal pancreatectomy(DP). Intraoperative indocyanine green(ICG)fluorography showed that the remnant stomach was perfused under the clamp of the splenic artery. We also confirmed that regional oxygen saturation (rSO2)of the remnant stomach was not decreased by the clamp. Based on the findings, we judged that blood flow in the remnant stomach was preserved at the clamp. We then performed DP with preservation of the remnant stomach. Postoperative complications associated with the remnant stomach were not observed. The patient is alive without any postoperative recurrences of pancreatic cancer or trouble associated with the remnant stomach 22 months after the surgery. This case suggested that ICG fluorography and rSO2 monitoring are useful to evaluate blood flow in the remnant stomach.

[A Case of Resection of a Mucinous Cystic Neoplasm of the Liver].

A 55 -year-old woman presented at our hospital in 2017. In 2014, a large cyst had been detected in her liver by ultrasonography, and she was followed up at a clinic. Abdominal computed tomography(CT)revealed a large multilocular cystic tumor measuring 12 cm in diameter in the left lobe of the liver. Although no solid component was identified in the tumor, the cystic tumor was increasing in size, and the serum level of CA19-9 was elevated. Under a preoperative diagnosis of mucinous cystic neoplasm(MCN)of the liver, we performed extended left liver lobectomy. There were no postoperative complications. Histopathological examination of the resected specimen revealed low-grade intraepithelial neoplasia, and the epithelium covered an ovarian-type stroma. The ovarian-type stromal cells were immunoreactive for estrogen receptor and progesterone receptor. The definitive diagnosis of the tumor was MCN of the liver with low-grade intraepithelial neoplasia. Eight months after the surgery, the patient remains alive without any recurrence.